News | “Too fat” is not a diagnosis: U.S. medicine is working to address weight bias
When 34-year-old Melissa Boughton told her obstetrician-gynecologist about persistent dull pain in her lower abdomen, the doctor’s first response was: “How have your diet and exercise been lately?”
She had heard questions like this too many times. During the same visit, the doctor repeatedly said losing weight might ease the pain, then offered to arrange an ultrasound to “put her mind at ease.”
The result was unexpected: a 7-centimeter fluid-filled tumor on her left ovary.
“It was as if she did not take my pain seriously at all,” Boughton said. “I felt that when she entered the room, she saw only my size, not my symptoms.”
Medical bias is not an isolated issue: patients with obesity are labeled in clinical settings
Multiple studies have shown that patients who are overweight or have obesity are more likely to be dismissed, overlooked, or even misdiagnosed in healthcare. According to the U.S. Centers for Disease Control and Prevention (CDC), about three-quarters of U.S. adults are overweight or have obesity, and Mississippi’s obesity rate is as high as 40%.
Although obesity is a treatable condition strongly associated with diabetes, cardiovascular disease, and certain cancers, it remains highly stigmatized in clinical practice. Anti-fat bias among physicians can appear as hasty judgments, poor listening and empathy, or attributing every symptom to excess weight.
Education gap: fewer than 10 hours on obesity in medical school
Dr. Scott Butsch, director of obesity medicine at Cleveland Clinic, said bluntly:
“This is almost medical negligence. When a doctor attributes everything to ‘you are too fat’ without conducting a careful evaluation, that is bias in clinical practice.”
He said that during his years teaching at Harvard Medical School, the entire four-year curriculum included no more than 9 hours on obesity.
A survey of 40 U.S. medical schools found that only 10% believed their students were “very competent” in addressing obesity-related issues. More concerning, half explicitly stated that obesity education was not a priority.
Two reforms underway: assessing interpersonal skills and incorporating anti-bias standards
To address this systemic issue, the Association of American Medical Colleges (AAMC) is working in two areas:
PREview professional readiness exam: evaluates medical students’ cultural sensitivity, empathetic communication, social skills, and other interpersonal abilities as a supplement to medical school admissions. More than ten schools now require or recommend it.
New diversity, equity, and inclusion (DEI) curriculum standards: beginning in June 2022, these standards cover current medical students, residents, and practicing physicians, including racial bias, implicit discrimination, gender equity, and communication about obesity.
Lisa Howley, PhD, senior director of strategy at AAMC, said: “Bias against patients with obesity is deeply rooted, and we still have much work to do.”
Routine to physicians, dismissive to patients
For Melissa Boughton, even after finding the tumor, the obstetrician-gynecologist who recommended diet and exercise still dismissed it as “nothing serious.” Boughton ultimately switched to a physician who promoted health at every size and immediately referred her to a surgical oncologist.
During surgery, doctors removed her left ovary and part of a fallopian tube. Fortunately, the tumor was benign. However, her fertility was affected, and she is receiving assisted reproductive treatment.
“For me, it was physically and emotionally painful. I was only 34 and had to go through all of this,” Boughton said.
The experience strengthened her resolve to retain the right to change doctors.
“You can ask me once whether I exercise and manage my diet—that is fair. But if you ask a second time, I know it is time to find someone else.”
News | “Too fat” is not a diagnosis: U.S. medicine is working to address weight bias
News | “Too fat” is not a diagnosis: U.S. medicine is working to address weight bias
When 34-year-old Melissa Boughton told her obstetrician-gynecologist about persistent dull pain in her lower abdomen, the doctor’s first response was: “How have your diet and exercise been lately?”
She had heard questions like this too many times. During the same visit, the doctor repeatedly said losing weight might ease the pain, then offered to arrange an ultrasound to “put her mind at ease.”
The result was unexpected: a 7-centimeter fluid-filled tumor on her left ovary.
“It was as if she did not take my pain seriously at all,” Boughton said. “I felt that when she entered the room, she saw only my size, not my symptoms.”
Medical bias is not an isolated issue: patients with obesity are labeled in clinical settings
Multiple studies have shown that patients who are overweight or have obesity are more likely to be dismissed, overlooked, or even misdiagnosed in healthcare. According to the U.S. Centers for Disease Control and Prevention (CDC), about three-quarters of U.S. adults are overweight or have obesity, and Mississippi’s obesity rate is as high as 40%.
Although obesity is a treatable condition strongly associated with diabetes, cardiovascular disease, and certain cancers, it remains highly stigmatized in clinical practice. Anti-fat bias among physicians can appear as hasty judgments, poor listening and empathy, or attributing every symptom to excess weight.
Education gap: fewer than 10 hours on obesity in medical school
Dr. Scott Butsch, director of obesity medicine at Cleveland Clinic, said bluntly:
“This is almost medical negligence. When a doctor attributes everything to ‘you are too fat’ without conducting a careful evaluation, that is bias in clinical practice.”
He said that during his years teaching at Harvard Medical School, the entire four-year curriculum included no more than 9 hours on obesity.
A survey of 40 U.S. medical schools found that only 10% believed their students were “very competent” in addressing obesity-related issues. More concerning, half explicitly stated that obesity education was not a priority.
Two reforms underway: assessing interpersonal skills and incorporating anti-bias standards
To address this systemic issue, the Association of American Medical Colleges (AAMC) is working in two areas:
PREview professional readiness exam: evaluates medical students’ cultural sensitivity, empathetic communication, social skills, and other interpersonal abilities as a supplement to medical school admissions. More than ten schools now require or recommend it.
New diversity, equity, and inclusion (DEI) curriculum standards: beginning in June 2022, these standards cover current medical students, residents, and practicing physicians, including racial bias, implicit discrimination, gender equity, and communication about obesity.
Lisa Howley, PhD, senior director of strategy at AAMC, said: “Bias against patients with obesity is deeply rooted, and we still have much work to do.”
Routine to physicians, dismissive to patients
For Melissa Boughton, even after finding the tumor, the obstetrician-gynecologist who recommended diet and exercise still dismissed it as “nothing serious.” Boughton ultimately switched to a physician who promoted health at every size and immediately referred her to a surgical oncologist.
During surgery, doctors removed her left ovary and part of a fallopian tube. Fortunately, the tumor was benign. However, her fertility was affected, and she is receiving assisted reproductive treatment.
“For me, it was physically and emotionally painful. I was only 34 and had to go through all of this,” Boughton said.
The experience strengthened her resolve to retain the right to change doctors.
“You can ask me once whether I exercise and manage my diet—that is fair. But if you ask a second time, I know it is time to find someone else.”
Source:
Collected online